The
most important factor to remember before getting a breast augmentation
is that enlarging what nature has given you is basically all that is
going to happen. So if you have flaws going into this surgery, and
they are not addressed during the procedure, then you will be able to
see these flaws more pronounced.

Asymmetry with the breasts is
usually addressed during the procedure, so that you will end up with a
more aesthetic look – however, it is imperative that you address your
problem BEFORE the surgery with your plastic surgeon. Each
patient is unique and is like a canvas to the plastic surgeon.
What you might see in a magazine might not be feasible with your own
anatomy, so understanding this before the surgery will allow you to make
a more rational and informed decision with getting implants.

Of
course if the plastic surgeon has chosen the wrong implants for you or
the wrong placement, then this can lead to overall dissatisfaction.
However, in general all women undergoing this procedure are normally
very happy with their end result they achieve.

Patient has a very wide space
in-between the cleavage area both pre op and post op.

Implant displacement and
asymmetric position is the second most frequent complaint by the patient after
augmentation. Implant positioning that is too high, too low, or too
lateral after an appropriate waiting period may require a surgical procedure to
improve the pocket location.

Breast implant mal-position
sometimes happens, and can be the cause of an inappropriate choice of implant,
technical surgical error at the time of surgery, or implant displacement at a
later time due to factors related to the implant such as weight. Mal-positioned
implants become displaced also due to capsular contracture.

Postoperative elastic banding to the upper poles of the
breast help to prevent implants from remaining high after sub-pectoral placement.
Normally a period of one to three months may be required for the strap to be
worn continuously in order to improve this problem before considering any
surgical intervention. As a general rule, most plastic surgeons do not
like to perform a secondary revision surgery before six months and depending on
the patient, it might be longer.

Rotation of anatomical implants that produces a
noticeable deformity sometimes is treated first with "taping" of the breast
mound for several weeks to allow for a capsule to form around the textured
implant. If this fails to help keep the implant stationary - a revision surgery
is performed to secure the pectoral fascia or the pocket by suturing to create a
tighter fit around the implant.

Implants that are malpositioned
can be:

too high

too low

too lateral

too medial

If both implants are too medial
(near the sternum) where the implant pocket is over-dissected, then
symmastiacan
occur.

Sometimes a patient might exhibit
a combination of mal-positions that are noted to a greater degree in certain
postures or positions than others, such as lying down versus standing
up. Significant lateral implant mal-position is often more accentuated in the
supine position (lying down) in which the entire implant literally falls off of the chest
wall into the arm pit area. The medial area of the implant in the supine
position tends to appears to look empty or flat.

Photo A
Photo B
Photo C

Lateral implant malposition in
patient who is 3 years post operative from breast augmentation with the trans-axillary
incision - under the muscle - smooth shell saline implants. Both sides have
malposition, however; is worse on the right side.

Photo A: Patient
has wide spaced cleavage and the right implant is sitting off to the side.

Photo B: The right implant is accentuated
laterally with the arms in the raised position.

Photo C:
Also in the "supine" position or lying down. Implants are falling into the
armpits.

Most surgeons will agree that
implant malposition is not uncommon, and is seen quite frequently. Implant
dislocation is the second most common reason for a revision
surgical procedure.

If a
patient needs a revision to fix any problems, most plastic surgeons will
give their existing patients a “returning patient discount”. Make
sure what the plastic surgeon’s policies are before the actual
procedure, so that you are always on the same page with communication.

Some plastic surgeons, depending on
the case might have you in a "strap"
after surgery. The strap is placed above the breasts in a
tight compression bandage which will help the breast implant to drop
down into the pocket. If you are instructed to wear the strap
to help with the dropping of the implants, make sure you wear it
according to your surgeon's instructions. The sooner the
implant drops into place, the better it is for the patient.